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Once a doctor…

Like buses, life events come in threes.

I had a significant birthday this year. Since then, if I can’t remember a word or a name, I presume my mind is going. Overnight one end of life looks much nearer. I’m beginning to understand the elderly patient who was afraid of dying and begged her daughter to come with her. The exit is closer and more real.

Then a friend commented acerbically that he was in his 80th year so I kept quiet.

I’m officially retired too. That makes me feel really old. Still, after a year without pay, it’s nice to get a payslip again. No, I won’t be getting the back money owed to consultants – I stayed on the old contract.

Retirement is odd. I don’t know who I am anymore. Medical life is so intense, all-absorbing, overwhelming. It takes over everything and then it’s gone.

I miss the patients and their relatives. I miss the family of Nenagh Hospital staff and being part of a small centre of excellence.

I don’t miss the whittling away of services needed for ill patients. I don’t miss the increasingly centralised bureaucracy.

One of the most surreal moments was watching two senior managers debate how to replace a specialist nurse. The post and budget were already agreed. Nurses had expressed interest in the temporary post. My colleagues spent 15 minutes trying to find a way through the bureaucracy to make it happen. They failed.

When I first came to Nenagh, we didn’t have specialist nurses. But Matron (who happened to be a man) could fill a vacant post. Now there are Managers and Nurse Managers, but they have less authority.

As for the HSE at national level, I don’t understand the structures at all. I wonder who does.

Of course, I’m much too young to retire. It’s just that my eyesight isn’t up to the job anymore. I’m very short-sighted, minus 20 in both eyes, with retinal distortions. When I became long-sighted as well, it was a struggle to read quickly under pressure. The final straw was having urgent surgery for a macular hole; I can’t read with that eye.

Maybe I could have coped in the old system. Life on the wards was orderly and efficient. Patient safety started with the doctor and nurse knowing each case well, often over several years. In the new regime, patients move from hospital to hospital to find a bed; nurses change from ward to ward. It can be hard to know a patient’s name, whatever about a detailed clinical history.

A patient may be stabilised in University Hospital Limerick, then transfer to Nenagh accompanied by an inch of photocopied records. The results are on two laboratory IT systems, one each for UL and Nenagh, and two x-ray IT systems. Reconciling medication is difficult when you don’t know if a drug was omitted by accident or on purpose. Within a hospital it’s easier to ask someone.

Some people think the answer is electronic records, but often the real problem is too much unprioritised information. Hospital medicine is fast-moving and we use a lot of verbal information. It’s the quickest way to assemble complex data in order to make decisions or take action. The written record follows afterwards and is not necessarily complete.

I’ve always regarded it as part of my job to check details in order to catch potential errors. Unfortunately, when patients move a lot, there is so much more to check. I got slower and slower and I got scared.

 A colleague in a similar situation said the solution is to develop central neuropathy and peripheral neuropathy and continue.

The third life event is coming up: A letter from the Medical Council reminds me I haven’t paid my registration fee. I’ve almost, nearly decided not to. It feels like a bereavement. Being a doctor has been part of me for so long.

The problem is Continuing Medical Education (CME). I’m attending conferences and reading. I’ve been told I’m meeting the requirements. But I get addled when faced with forms and anyway, how can I do an audit? I don’t even know if CME is different for my sick leave. I’m so pathetic, I don’t deserve to be on the Medical Register.

I’m still Dr O’Malley or Dr Christine to a lot of people. People continue to ask for advice, or expect me to attend to a seriously injured neighbour in a dark field.

Feeling old? Get over it. Retired? Now that Annie is happy in Cardiff I wonder what I’ll do this winter.

But whether on or off the Medical Register, there’s no such thing as an ex-doctor.

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